Nipah virus raises a serious alarm

The state of Kerala needs to combat this deadly virus with caution and spread awareness among the common public. We need to follow these precautions religiously as the mortality rate of the Nipah virus is more than 70 per cent. Kozhikode (Calicut) is most affected. In early days, Elephantiasis gave jitters to the people of North Malabar and now Nipah.

The tragic death of the nurse taking care of a Nipah virus infected patient reflects that the precautions taken till now are ineffective. This raises a serious alarm and calls for the attention of the medical authorities to ensure that effective precautions are duly followed and no such incidents take place in future. Till then, folks please take all necessary actions — wash your hands and wear mask when moving around in public. “Prevention is the only cure” seems to be the case in the current situation. My condolences and solace to all near and dear ones of the victim who have fallen prey to this fatal virus.

We can’t say that the nurse inadvertently avoided precautions. Actually the nurse who died was the one who took care of the first Nipah patient. And the first patient was confirmed Nipah from his blood samples only after he was died. Nipah virus (NiV) infection is a newly emerging virus that causes severe disease in both animals and humans. The natural host of the virus are fruit bats that spread the virus.

In the 1999 outbreak, Nipah virus caused a relatively mild disease in pigs, but nearly 300 human cases with over 100 deaths were reported. In order to stop the outbreak, more than a million pigs were euthanized, causing tremendous trade loss for Malaysia. Since this outbreak, no subsequent cases (in neither swine nor human) have been reported in either Malaysia or Singapore.

In 2001, NiV was again identified as the causative agent in an outbreak of human disease occurring in Bangladesh. Genetic sequencing confirmed this virus as Nipah virus, but a strain different from the one identified in 1999. In the same year, another outbreak was identified retrospectively in Siliguri, India with reports of person-to-person transmission in hospital settings. Unlike the Malaysian NiV outbreak, outbreaks occur almost annually in Bangladesh and have been reported several times in India.

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The good news is that Kerala’s public health systems have acted with extraordinary efficiency so far. Doctors identified the virus in the very second patient, a diagnostic speed unrivalled in developing countries. This must be commended. But big challenges remain. The death of a nurse shows that health-care workers may not be taking adequate precautions when dealing with patients, by using masks and following a strict hand-wash regimen. The virus has no specific treatment. The best defences against it are the age-old principles of infection control, which Indian hospitals have not mastered as yet. Kerala’s health authorities must ensure these principles are widely adopted, and act in preventive the disease in an epidemic form.

Seasonal change could also be a possible threat. It was found that the period between April to June was most vulnerable to the Nipah virus outbreak – with things getting worse during the month of May. It is better to be careful during this outbreak as we used to do during Swine Flu days. Nipah already kills up to 70 per cent of those it infects, through a mix of symptoms that include encephalitis, a brain inflammation marked by a coma state, disorientation, and long-lasting after-effects, such as convulsions, in those who survive.

Preliminary reports suggest that the Kozhikode outbreak is also displaying a stuttering chain of transmission. Of the 11 confirmed Nipah fatalities, three were from the same family. It is time to take preventive measures and see that outbreak does not spread to other neighbouring cities of North Malabar in general and Kerala in particular.